Endovascular Management of Acute Proximal Internal Carotid Artery Occlusion: the JHN Experience

Stroke is a major cause of serious, long-term disability and the third leading cause of death, accounting for one in every 18 deaths in the United States. Approximately 800,000 strokes occur in the United States each year, leading to an estimated cost of 74 billion dollars in 2010. The severity and prognosis of patients with an acute internal carotid artery (ICA) occlusion is extremely poor. Studies have shown that 16-55% of patients will die from complications related to the infarction, 40-69% will be left with a profound deficit, and only 2-12% will make a reasonable recovery2. In young patients, internal carotid artery dissections presenting as an acute occlusion or thrombotic clot are responsible for approximately 14-20% of ischemic strokes.1 Results from trials utilizing emergent open surgical carotid recanalization or IVtPA have not been encouraging2,3. Recently, there have been small case reports of endovascular stent-assisted thrombolysis as a treatment option for patients with carotid occlusions and near occlusions.4-